Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage!

Table 5 Presepsin for prognosis of sepsis

Ref.	Type of study	Patient population	Aim	No. of studies/patients	Results	Conclusion of study
Masson et al[33], 2015	Retrospective case control study	Adults	To evaluate the prognostic value of presepsin and comparison with procalcitonin	100	Presepsin levels at day 1 were higher in decedents (2269 pg/mL, median-1171 to 4300 pg/mL) than in survivors (1184 pg/mL, median-875 to 2113 pg/ml); P = 0.002) whereas PCT was not different (18.5 mcg/L, median 3.4 to 45.2) and 10.8 mcg/L (2,7 to 41.9 mcg/L) P = 0.13). The evolution of presepsin levels over time was significantly different in survivors compared to non survivors (P for time-survival interaction-0.03)	Presepsin showed better prognostic accuracy than procalcitonin in the range of SOFA. (AUC: 0.64-0.75 vs AUC: 0.53-0.65)
Behnes et al[55], 2014	Prospective cohort study	Adults	Evaluation of diagnostic and prognostic value of presepsin in sepsis and septic shock patients during the 1st wk of ICU treatment	116	AUC- 0.64 TO 0.71; Presepsin cut off values-Sepsis-530 pg/mL; Severe sepsis-600 pg/mL; Septic shock-700 pg/mL	Presepsin has good prognostic value in terms of prognosis for 30 d and 6 mo all cause mortality throughout the 1st wk of ICU stay and its prognostic value for all cause mortality is comparable to that of IL6 and better than that of PCT, CRP or WBC
Yang et al[56], 2018	Meta-Analysis	Adults	To evaluate the mortality prediction value of presepsin in septic patients	10 studies; 1617 patients	Initial prespesin levels (within 24 h) were significantly lower in survivors as compared to non survivors. Pooled SMD (standardized mean difference) between survivors and non survivors-0.92 (95%CI: 0.62–1.22)	Some mortality prediction of presepsin; further studies may be needed to define optimal cut off points for presepsin to predict mortality in sepsis
Wang et al[57], 2020	Observational	Elderly patients	To investigate the prognostic value of presepsin for elderly septic patients in ICU	142	Presepsin levels were significantly higher in infected patients. Day 3 presepsin levels showed a significant prognostic value for 30 d mortality but was not found to be superior to other biomarkers	Early diagnostic ability comparable to that of PCT; however not a perfect biomarker for prognosis of 30 d mortality in elderly patients
Koh et al[58], 2021	Observational	Adults	Estimation of prognostic value of presepsin in septic patients	153	AUC for presepsin- 0.656; Presepsin levels > 1176 pg/mL (odds ratio 3.352, P < 0.001) was a risk factor for in hospital mortality	Non survivors had higher presepsin levels; presepsin may have prognostic value
Endo et al[59], 2014	Prospective study	Adults	To compare presepsin with other conventional biomarkers (PCT, CRP, IL6) for evaluating the severity of sepsis	103	In patients with unfavorable prognosis: (1) Presepsin levels did not decrease significantly during follow up; (2) Higher duration of antibiotic therapy was used (P < 0.05); and (3) Higher 28 day mortality (P < 0.05)	Presepsin levels correlated with severity during follow up as compared to other conventional biomarkers
Masson et al[33], 2015	Observational	Adults	Evaluating the relationship between presepsin levels and host response, appropriateness of antibiotics, and mortality in severe sepsis patients	997 patients with severe sepsis or septic shock in ALBIOS trial	Baseline Presepsin concentrations increased with SOFA score, number of organ failures, and incidence of new organ failures; An increasing concentration of presepsin from day 1 to day 2 predicted higher ICU (P < 0.0001) and 90 d mortality (P < 0.01)	Presepsin is an early predictor of host response and mortality in patients with sepsis

AUC: Area under the receiver operator characteristic curve; CRP: C-reactive protein; IL6: Interleukin 6; PCT: Procalcitonin; WBC: White blood cell count.